The Doctor Who Invented PSA Test Calls It “A Profit-Driven Public Health Disaster” . . . Why This Is Good News

Times are changing. Americans are beginning to acknowledge that “early detection” is not the absolute answer to cancer. And many are  recognizing that what seems a simple diagnostic test can carry more risks than benefits.

Tuesday, the New York Times ran an Op-ed by Richard J. Ablin,  the man who invented the prostate-specific-antigen (PSA) test which is widely used to detect signs of  early-stage prostate cancer.  Ablin, who is  now a research professor of immunobiology and pathology at the University of Arizona College of Medicine and the president of the Robert Benjamin Ablin Foundation for Cancer Research,  reveals that “in approving the procedure, the Food and Drug Administration relied heavily on a study that showed testing could detect 3.8 percent of prostate cancers, which was a better rate than the standard method, a digital rectal exam.

Your Yearly Physical Is a Waste of Time

…or at least that’s what some experts have increasingly been suggesting. According to the American College of Physicians (ACP), instead of having an annual physical, “healthy adults should undergo a much-streamlined exam that’s focused on prevention every one to five years depending on a person’s age, sex and medical profile.”

So what does that mean, exactly? According to the U.S. Preventive Services Task Force, doctors should focus on “interventions that help patients change health-impairing habits or that spotlight emerging illnesses for which reliable and effective treatments exist.”  These include “Pap smears, mammograms, cholesterol tests, blood-pressure checks, and counseling to stop smoking, lose weight, get more exercise and eat a healthier diet.” In other words, rather than just checking for everything, doctors should focus on interventions that can be substantively linked to treatments we know work. Currently, most check-ups are comprehensive run-throughs that seem to be administered  just for their own sake, regardless of how, or even if, they relate to meaningful treatments.

For many of us, the annual physical is a fixture of our health care experience, something we assume to be both necessary and desirable. Indeed, a study released last month found that 64 million Americans a year get a physical or gynecological exam, costing a total of $7.8 billion.  Regular gynecological exams are important—they include Pap smears that have made cervical cancer a rare disease. But the point of the general physical is less clear.  More people get annual check ups than visit doctors for respiratory conditions or high blood pressure, and the price tag for yearly physicals closes in on the $8.1 billion spent on breast cancer care.

Human Growth Hormone and The Business of Immortality

Last week, James Forsythe, a prominent doctor in Reno, Nevada was acquitted by a federal jury after going to trial on allegations that he trafficked in human growth hormone (HGH). The decision came as a relief to the American Academy of Anti-Aging Medicine (A4M), because among other allegations, the doctor was accused of selling HGH as an anti-aging treatment, which is illegal in the U.S. A4M has a history of pushing for HGH-driven anti-aging treatments.

So what’s so special about HGH when it comes to aging? Beginning in your 40s, the pituitary gland slowly reduces the amount of hormone it produces, a fact that some feel is both responsible for the frailty of age and reversible through the introduction of synthetic growth hormones.

But there is little, if any, reliable scientific evidence about the anti-aging benefits of HGH. In fact, there are no double-blind placebo-controlled studies for most of the anti-aging miracle cures out there. Yet we do know for a fact that HGH can increase the risk of cancer—not to mention edema (retention of fluids), arthralgia (joint pain), carpal tunnel syndrome, diabetes, and gynecomastia (enlarged mammary glands in males).  Oh, and it might actually shorten life.

What Rudy--and Most Americans--Still Don’t Understand about Prostate Cancer

Presidential candidate Rudy Giuliani recently made the mistake of trying to turn his brush with prostate cancer into a campaign issue: “I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, [is] 82 percent. My chances of surviving prostate cancer in England, [is] only 44 percent under socialized medicine,” Giuliani declared.

Rudy, of course, was wrong.

Merrill Goozner has done the best job that I’ve see of cutting through to the truth of the matter. In a Nov. 2  post titled “Columnists Miss Chance to Educate on PSA Testing,” he points out that “Paul Krugman's column in the New York Times and Eugene Robinson's column in the Washington Post justifiably attack Rudy Giuliani's misuse of prostate cancer stats, all but accusing him of lying.

A Transaction Based on Trust

The consumer of health care is unlike any other consumer, and the product he purchases is unlike any other product. This is something that those who embrace “consumer-driven medicine” choose to ignore.

Advocates like Harvard Business Professor Regina Herzlinger insist that if we just
put the consumer in the driver’s seat, giving him both  transparent pricing and a little “skin in the game,” the consumer  could put a lid on health care prices while demanding the best quality care.  Herzlinger is particularly hopeful that the baby-boomers, a group she describes as “the most manipulative, the most narcissistic and the most effective generation this country has ever seen,” can do the job. (Why one would want such a group setting priorities for our health care is beyond my understanding; I’ll return to this point in a later post.)

Last week I spoke at the Massachusetts’ Medical Society’s Leadership Forum on the rising cost of care.  In two earlier posts (here and here) I’ve described what other speakers had to say about how and why Massachusetts is running into trouble trying to fund its experiment in universal care.

In my speech, I explained why I don’t think that “consumer-driven medicine” is the answer. I don’t believe the “consumer” can rein in healthcare spending.  As an alternative, I proposed a “patient-centered” model of health care which depends on patient and doctor, working together.

Begin with the flaws in the consumer-driven model. First, it assumes that the patient has the same power that a buyer has in the commercial marketplace. But in truth, the patient does not have nearly as much leverage as other consumers.

We Can’t Fund SCHIP, But We Can Save Merck

Today, Bloomberg trumpeted the good news:  “Merck Profit Gains on Cancer Vaccine, Diabetes Pill.”

“Merck & Co., the third-largest U.S. drugmaker, reported a 63 percent gain in earnings,” Bloomberg reported, a victory made doubly by the fact that Merck has seen some rough times. “Competition from generics and the withdrawal of the pain pill Vioxx in 2004 over heart risks have pulled net income down 39 percent since 2001,” the story explained. Indeed, Vioxx gave Merck a black eye, and it’s still battling lawsuits in the courts. But Gardasil, Merck’s new vaccine to prevent cervical cancer, is turning out to be just the blockbuster the company needed. “Gardasil, introduced a year ago [already] has sales of $418 million”

Those of you familiar with my views on Gardasil may want to skip the below section, as it is pulled from an August post. I promise I won’t do this often, but this is an important subject and it’s example of how, if drug manufacturers and their lobbyists work quickly enough, they can sell their story to politicians and to the public before skeptics in the scientific community have a chance to weigh in. Remember the drug industry saying: “It’s important to sell a new drug while it’s still effective” (i.e. before people know too much about it).

On August 27, I wrote:

Earlier this month the FDA announced that the direct-to-consumer ads Merck has been using peddle its new cervical cancer vaccine, Gardasil, are “half-true . . .information currently being advertised could mislead the public.” 

Comment on Class and Health

(To see the original post on Class and health, click here.  To add your comment, scroll down and click on “Contact” on the left-hand side of the page.)

From Alan Abrams (a.k.a. Alan_A at the hpscleansing.com/group community forums)

I just read Maggie Mahar's health blog after linking to it from an agonist.org blog on universal health care. I then read Maggie Mahar's blog [post] on "Class and Health."  thus this quote:

"And yet, and yet . . . Schroeder sees reason for "cautious optimism." Although we trail behind other countries, we are healthier than we once were. We have reduced smoking ratse, homicide rates and motor-vehicle accidents. Vaccines and cardiovascular drugs have improved medical care. But progress in other areas will require "political action," Schroeder declares, "starting with relentless measurement of and focus on actual health status and the actions that could improve it. Inaction means acceptance of America's poor health status."

Healthier than we once were? Really?  Are…smoking, homicide rates, and motor-vehicle accidents adequate measures of the overall improving general health of Americans?

What about these:

• 58 Million Overweight; 40 Million Obese; 3 Million morbidly Obese
• Eight out of 10 over 25's Overweight
• 78% of American's not meeting basic activity level recommendations
• 25% completely Sedentary
• 76% increase in Type II diabetes in adults 30-40 yrs old since 1990

If We Mandate Insurance, Should 20-Somethings Pay Less?

Should insurers be able to offer less expensive policies to the young and healthy? Or should they be required to offer the same benefits to everyone at the same price?

In states where insurance is mandated, should twenty-somethings get a break? In a post on Health Care Policy and Marketplace Blog Robert Laszewski addresses these questions. He begins by focusing on a report  just released by the health insurance trade association (AHIP). The study looks at state health insurance reforms of the 1990s that tried to eliminate discrimination by insisting that insurers must sell “individual” policies to people who are not covered by an employer or another group without discriminating on the basis of health, age or gender. According to the AHIP, these reforms have had some “unintended consequences.”

Commenting on "The FDA Betrays its Mandate"

Commenting on "The FDA Betrays its Mandate,"  Gregory D. Pawelski  responded:

Take Physicians Out of the Retail Pharmacy Business

Lee Newcomer, with United Health Group, had stated at the 12th annual conference of the National Comprehensive Cancer Network, 44% of patients having blood work-ups indicated they were not anemic. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, reiterated that Newcomer was right on the spot on this. Few drugs work the way we think and few physicians/scientists take the time to think through what it is they are using them for.

A New York Times article stated that anemia drugs, given by injection, have been heavily advertised, and there is evidence that they have been overused, in part because oncologists can make money by using more of the drug. Lichtenfeld told United Press International, "Probably more than a billion dollars is spent on erythropoietin each year, which makes it one of the most expensive cancer drugs."

Update--Gardasil for Boys?

A study published today in the journal Cancer suggests that cancers of the tongue and tonsils may be associated with the HPV virus that is linked to  cervical cancer. The theory is that  boys may contract the cancer through oral sex.  No surprise, the media is now asking: "Should boys be vaccinated with Garadasil too? (See my post below on Direct-to-Consumer advertising recommending Gardasil, a vaccine the against some cases of cervical cancer, for girls.)

The Wall Street Journal's Health Blog takes a cautious approach pointing out, first, that "HPV's connection to  to oral cancer isn’t as clear-cut as its role in cervical cancer," though  a New England Journal of Medicine article published earlier this year suggested a strong association. Moreover, while Merck and its rival GlaxoSmithKline (which is also developing a vaccine for cervical cancer) have done some  research on using their HPV vaccines in boys, they have even less data for boys than they have girls.  Finally,  "this form of cancer is rare.  . . .So for the time being, the vaccine, which costs $360 for a three-dose regimen, seems unlikely to be given to boys."

The Journal's healthblog also notes that one of the study's two authors "has worked as a consultant for GlaxoSmithKline."